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Topical news & information about current health related issues
Sunday, October 03, 2004
Measles epidemic predicted
Due to the media hype over the once-proposed link of MMR to autism and inflammatory bowel disease, immunisation levels have fallen to low enough levels in the community to allow a measles epidemic according to computer modelling by the Health Protection Agency. As many as 12% of all children and 20% of adults will be hospitalised if infected. It can be a very serious disease sometimes leaving permanent damage and even death. A consultant epidemiologist at the HPA, Dr Mary Ramsay was quoted in Pulse, the GP weekly, saying, " We're predicting an epidemic and many places in London are already at a point where an epidemic can occur" (due to low MMR uptake). An emergency response programme is being drawn up.
It is a good idea if you have un-immunised children, to get them to have the MMR jab to reduce the risk of their infection.
The MMR scare story is now old news and we suggest if you have any lingering doubts to study the evidence for yourself. A good place to start, where all the studies and the background issues are presented, is the following website: MMR the facts.
It is a good idea if you have un-immunised children, to get them to have the MMR jab to reduce the risk of their infection.
The MMR scare story is now old news and we suggest if you have any lingering doubts to study the evidence for yourself. A good place to start, where all the studies and the background issues are presented, is the following website: MMR the facts.
Saturday, June 26, 2004
Smoking shortens your life by 10years - new research details
In 1956 Sir Richrad Doll and A. Bradford Hill ppublished one of the most important scientific papers ever. By studying the health of British doctors who smoked it proved unequivocally for the first time that smoking causes lung cancer and death from a range of other adverse health effects.
In a follow up study on those doctors just published in the British Medical Journal, the ill-effects of smoking are found to be even greater:
* Half to 2/3rds of all smokers will die from their habit.
* Smoking doubles or triples your risks of dying prematurely.
* Smoking will shorten your life by around 10 years.
* In the 50yrs on this study, 6 million British people have died from smoking.
* All the benefits over the last few decades of increased life expectancy are obliterated by smoking.
* Starting smoking at an earlier age shortens life considerable - this is worrying as the age of starting smoking is nowadays earlier than in the past, often as early as 10 or 11 years.
* Quitting at any age is worthwile: a 60yr old smoker will gain 3 years of life. A 30 yr old smoker will gain back the 10yrs that would be lost by continuing to smoke. If you stop at the age of 40 you will gain 9 years of life, if aged 50, 6 years.
If you wish to stop smoking and are having difficulty, please make an appointment to see the Nurse or Doctor or book at reception for our Smoking Cessation Clinic.
In a follow up study on those doctors just published in the British Medical Journal, the ill-effects of smoking are found to be even greater:
* Half to 2/3rds of all smokers will die from their habit.
* Smoking doubles or triples your risks of dying prematurely.
* Smoking will shorten your life by around 10 years.
* In the 50yrs on this study, 6 million British people have died from smoking.
* All the benefits over the last few decades of increased life expectancy are obliterated by smoking.
* Starting smoking at an earlier age shortens life considerable - this is worrying as the age of starting smoking is nowadays earlier than in the past, often as early as 10 or 11 years.
* Quitting at any age is worthwile: a 60yr old smoker will gain 3 years of life. A 30 yr old smoker will gain back the 10yrs that would be lost by continuing to smoke. If you stop at the age of 40 you will gain 9 years of life, if aged 50, 6 years.
If you wish to stop smoking and are having difficulty, please make an appointment to see the Nurse or Doctor or book at reception for our Smoking Cessation Clinic.
Monday, October 13, 2003
Powerful Health Search engine AVAILABLE HERE!
The National Electronic Library for Health has a super search engine which probes all the top professional health journals and databases for any inforamtion you need.
Click here for NeLH
Click here for NeLH
The Risks of Breast Cancer with HRT
HRT and risk of breast cancer
The new research concerning hormone replacement therapy and breast cancer was the "Million Women Study" (actually performed on 800,000 women- 200,000 had to be excluded after initial screening to make sure only women who had had the menopause were included).
The women were aged 50 to 64 and they all attended the normal breast screening programme.
Half of them had taken HRT. Those taking the combined form of HRT (the sort given to those who still have a womb), had double the risk of breast cancer compared with those who hadn't taken HRT.
Women using the oestrogen only form of HRT, as given to those who have had a hysterectomy, were about a third more likely to get breast cancer.
It is estimated that if 1000 women take the combined form of HRT for 10 years, 19 of them get breast cancer because of the HRT.
An extra 5 breast cancers are likely to be caused in a 1000 women taking the oestrogen only HRT for 10 years.
This isn't entirely new knowledge, but until now we thought that the number of cases of breast cancer caused by HRT was smaller. The main benefits of HRT seem to be in reducing hot flushes, and relief of other unpleasant symptoms of the menopause, most of which get better with time and may in any case return to some degree when stopping the HRT. Many aspects of HRT previously thought to be useful, such as protection against heart disease, are now no longer thought to be beneficial and HRT is rapidly losing credibility in the medical profession as a sensible long-term option.
Risks and benefits vary according to your current and past health and that of your parents. Because everyone is different, advice about taking HRT has to be tailored to the individual. You may want to discuss this with us at a routine appointment.
In any case make sure your are aware of your breasts, check them from to time and come in for your routine checks with the nurse twice a year and for a cervical smear and internal examination with a doctor every 3 years.
Read the Guardian article here
The new research concerning hormone replacement therapy and breast cancer was the "Million Women Study" (actually performed on 800,000 women- 200,000 had to be excluded after initial screening to make sure only women who had had the menopause were included).
The women were aged 50 to 64 and they all attended the normal breast screening programme.
Half of them had taken HRT. Those taking the combined form of HRT (the sort given to those who still have a womb), had double the risk of breast cancer compared with those who hadn't taken HRT.
Women using the oestrogen only form of HRT, as given to those who have had a hysterectomy, were about a third more likely to get breast cancer.
It is estimated that if 1000 women take the combined form of HRT for 10 years, 19 of them get breast cancer because of the HRT.
An extra 5 breast cancers are likely to be caused in a 1000 women taking the oestrogen only HRT for 10 years.
This isn't entirely new knowledge, but until now we thought that the number of cases of breast cancer caused by HRT was smaller. The main benefits of HRT seem to be in reducing hot flushes, and relief of other unpleasant symptoms of the menopause, most of which get better with time and may in any case return to some degree when stopping the HRT. Many aspects of HRT previously thought to be useful, such as protection against heart disease, are now no longer thought to be beneficial and HRT is rapidly losing credibility in the medical profession as a sensible long-term option.
Risks and benefits vary according to your current and past health and that of your parents. Because everyone is different, advice about taking HRT has to be tailored to the individual. You may want to discuss this with us at a routine appointment.
In any case make sure your are aware of your breasts, check them from to time and come in for your routine checks with the nurse twice a year and for a cervical smear and internal examination with a doctor every 3 years.
Read the Guardian article here
Thursday, July 24, 2003
£1 superpill given to all over 55 yr olds could slash heart disease by 80%
The news that a combined pill could reduce the risk of heart attacks and strokes by 80% was reported in ten newspapers on 27 June 2003 (1-10). The research (11) behind this story was based on meta-analyses of the individual drug components proposed and the findings were generally accurately reported by the newspapers.
· Ten newspapers (1-10) reported that a new pill combining heart drugs and vitamins could cut the number of deaths from cardiovascular disease by 80%. They report that trials of the 'Polypill' are planned and most of the articles acknowledge that it would take years before the product would be available.
· The research was based on existing meta-analyses of different drugs that reduce cardiovascular risk factors. The authors conclude that the proposed Polypill could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. However, these conclusions are based on meta-analyses of the individual components of the Polypill which have not yet been tested in combination.
· The newspapers were generally accurate in their reporting of the research, and reported that trials were planned. Most acknowledged that it would be years before this drug could be made available.
Evaluation of the evidence base for 'Polypill' to reduce cardiovascular disease
Where does the evidence come from?
The evidence comes from research conducted by Professors Wald and Law of the Wolfson Institute of Preventive Medicine at the University of London. The authors have filed a patent application on the formulation of the combined pill described here, and a trademark application for the name 'Polypill'.
What were the authors' objectives?
The objective was to determine the combination of drugs and vitamins, and their doses, for use in a single daily pill (the Polypill) to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein (LDL) cholesterol, blood pressure, serum homocysteine and platelet function) regardless of pre-treatment levels.
What was the nature of the evidence?
The research used existing evidence from published meta-analyses of randomised controlled trials (RCTs) and cohort studies. In addition, a meta-analysis of 15 RCTs of low dose aspirin (50-125 mg/day) was carried out.
What interventions were examined in the research?
The authors identified categories of drugs or vitamins used to modify LDL cholesterol, blood pressure, homocysteine and platelet function and summarised selected previous research on these drugs.
For modifying LDL cholesterol, lowering blood pressure and reducing serum homocysteine, the authors drew conclusions from three of their earlier meta-analyses of statins, blood pressure lowering drugs and folic acid.
The authors performed a meta-analysis of 15 RCTs identified from three electronic databases and two previous meta-analyses on the effects of low dose aspirin (an antiplatelet agent) on the reduction in IHD events and stroke and its adverse effects.
The long term effect of a specified absolute reduction in LDL cholesterol, blood pressure and homocysteine expressed as the proportional reduction in the incidence of ischaemic heart disease (IHD) events and stroke was taken from four published sources that were based on systematic reviews of cohort studies, three of which were by the authors.
The authors calculated the combined effect of changing the four risk factors by multiplying the relative risks associated with each. A Markov model was used to calculate the years of life gained without a heart attack or stroke if people without a previous cardiovascular event used the Polypill from age 55.
What were the findings?
The authors report a 61% reduction in risk of an IHD event and a 17% reduction in risk of stroke with the use of statins to modify LDL cholesterol, a 46% reduction in risk of an IHD event and a 63% reduction in risk of stroke with three classes of drug to reduce blood pressure, a 16% reduction in risk of an IHD event and a 24% reduction in risk of stroke with folic acid for reducing serum homocysteine. The meta-analysis of low-dose aspirin indicated a 32% reduction in risk of an IHD event and a 16% reduction in risk of stroke.
The authors calculated the combined effect of the agents to have an 88% reduction in risk of an IHD event and an 80% reduction in risk of stroke. The authors stated that about a third of people taking the Polypill from age 55 would benefit, each gaining an average of 11-12 years free from an IHD event or stroke.
If the three classes of blood pressure lowering drugs with the lowest prevalence of adverse effects were used in a Polypill formulation, 8% of people taking the drug would be expected to have symptoms attributable to one or more of the six components of the pill, mostly due to aspirin. If the three least expensive blood pressure lowering drugs were used, about 15% of people taking the pill would be expected to have symptoms. Aspirin had the most serious adverse effects of all the components, mainly due to haemorrhage.
What were the authors' conclusions?
The authors conclude that the Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.
How reliable are the conclusions?
The authors' conclusions are premature since this proposed combined drug for the prevention of cardiovascular disease has not yet been clinically tested. Polypill would need to be rigorously evaluated in an RCT before conclusions could be drawn about its safety and effectiveness, particularly since the interactions of combining these drugs have not been investigated. It is likely that the Polypill would be controversial as it is a preventative drug which would be used to treat people with no diagnosed disease.
Systematic reviews
Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.
There were no related systematic reviews identified on the Cochrane Database of Systematic Reviews or on the Database of Abstracts of Reviews of Effects (DARE).
This report has been prepared for the National electronic Library for Health by the NHS Centre for Reviews and Dissemination, based at the University of York
· Ten newspapers (1-10) reported that a new pill combining heart drugs and vitamins could cut the number of deaths from cardiovascular disease by 80%. They report that trials of the 'Polypill' are planned and most of the articles acknowledge that it would take years before the product would be available.
· The research was based on existing meta-analyses of different drugs that reduce cardiovascular risk factors. The authors conclude that the proposed Polypill could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. However, these conclusions are based on meta-analyses of the individual components of the Polypill which have not yet been tested in combination.
· The newspapers were generally accurate in their reporting of the research, and reported that trials were planned. Most acknowledged that it would be years before this drug could be made available.
Evaluation of the evidence base for 'Polypill' to reduce cardiovascular disease
Where does the evidence come from?
The evidence comes from research conducted by Professors Wald and Law of the Wolfson Institute of Preventive Medicine at the University of London. The authors have filed a patent application on the formulation of the combined pill described here, and a trademark application for the name 'Polypill'.
What were the authors' objectives?
The objective was to determine the combination of drugs and vitamins, and their doses, for use in a single daily pill (the Polypill) to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein (LDL) cholesterol, blood pressure, serum homocysteine and platelet function) regardless of pre-treatment levels.
What was the nature of the evidence?
The research used existing evidence from published meta-analyses of randomised controlled trials (RCTs) and cohort studies. In addition, a meta-analysis of 15 RCTs of low dose aspirin (50-125 mg/day) was carried out.
What interventions were examined in the research?
The authors identified categories of drugs or vitamins used to modify LDL cholesterol, blood pressure, homocysteine and platelet function and summarised selected previous research on these drugs.
For modifying LDL cholesterol, lowering blood pressure and reducing serum homocysteine, the authors drew conclusions from three of their earlier meta-analyses of statins, blood pressure lowering drugs and folic acid.
The authors performed a meta-analysis of 15 RCTs identified from three electronic databases and two previous meta-analyses on the effects of low dose aspirin (an antiplatelet agent) on the reduction in IHD events and stroke and its adverse effects.
The long term effect of a specified absolute reduction in LDL cholesterol, blood pressure and homocysteine expressed as the proportional reduction in the incidence of ischaemic heart disease (IHD) events and stroke was taken from four published sources that were based on systematic reviews of cohort studies, three of which were by the authors.
The authors calculated the combined effect of changing the four risk factors by multiplying the relative risks associated with each. A Markov model was used to calculate the years of life gained without a heart attack or stroke if people without a previous cardiovascular event used the Polypill from age 55.
What were the findings?
The authors report a 61% reduction in risk of an IHD event and a 17% reduction in risk of stroke with the use of statins to modify LDL cholesterol, a 46% reduction in risk of an IHD event and a 63% reduction in risk of stroke with three classes of drug to reduce blood pressure, a 16% reduction in risk of an IHD event and a 24% reduction in risk of stroke with folic acid for reducing serum homocysteine. The meta-analysis of low-dose aspirin indicated a 32% reduction in risk of an IHD event and a 16% reduction in risk of stroke.
The authors calculated the combined effect of the agents to have an 88% reduction in risk of an IHD event and an 80% reduction in risk of stroke. The authors stated that about a third of people taking the Polypill from age 55 would benefit, each gaining an average of 11-12 years free from an IHD event or stroke.
If the three classes of blood pressure lowering drugs with the lowest prevalence of adverse effects were used in a Polypill formulation, 8% of people taking the drug would be expected to have symptoms attributable to one or more of the six components of the pill, mostly due to aspirin. If the three least expensive blood pressure lowering drugs were used, about 15% of people taking the pill would be expected to have symptoms. Aspirin had the most serious adverse effects of all the components, mainly due to haemorrhage.
What were the authors' conclusions?
The authors conclude that the Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.
How reliable are the conclusions?
The authors' conclusions are premature since this proposed combined drug for the prevention of cardiovascular disease has not yet been clinically tested. Polypill would need to be rigorously evaluated in an RCT before conclusions could be drawn about its safety and effectiveness, particularly since the interactions of combining these drugs have not been investigated. It is likely that the Polypill would be controversial as it is a preventative drug which would be used to treat people with no diagnosed disease.
Systematic reviews
Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.
There were no related systematic reviews identified on the Cochrane Database of Systematic Reviews or on the Database of Abstracts of Reviews of Effects (DARE).
This report has been prepared for the National electronic Library for Health by the NHS Centre for Reviews and Dissemination, based at the University of York
Wednesday, July 16, 2003
Prostate Cancer and Smoking: Fresh information
Smoking “linked to prostate cancer”
Tuesday, July 15, 2003
Smokers face increased risk of prostate cancer
LONDON
By Mark Cowen
Middle-aged men who have smoked regularly for most of their lives are 60 per cent more likely than non-smoking men to develop prostate cancer, according to US researchers.
Previous research results regarding the link between smoking and prostate cancer have been mixed, say the researchers from Fred Hutchinson Cancer Research Centre and the University of Washington.
However, the new study – in conjunction with recent findings from John Hopkins University and Harvard University – point to smoking being an important risk factor for prostate cancer, they say.
The researchers studied more than 1,450 men between the ages of 40 and 64. Half had a history of prostate cancer, while the rest acted as a comparison group. All the participants were interviewed about a variety of factors, including their smoking habits, diet, alcohol consumption and occupational history.
After analysing the results, researchers found significant evidence to suggest a link between smoking and prostate cancer.
They found that men under the age of 65 who had smoked around a packet of cigarettes each day for 40 years, or two packets a day for 20 years, had a 60 per cent increased risk of developing prostate cancer, compared with non-smoking men.
Furthermore, such men were twice as likely as their non-smoking peers to develop more aggressive forms of prostate cancer.
Writing in the July edition of the journal Cancer, Epidemiology, Biomarkers and Prevention, lead author of the study, Dr Janet Stanford, said, “This study provides additional evidence that supports a role for smoking as a risk factor for prostate cancer and confirms recent findings that suggest smoking is an even stronger risk factor for more life-threatening forms of prostate cancer.”
She added, “From a public-health perspective, I think we now have enough evidence to suggest that prostate cancer should be added to the long list of malignancies in which smoking plays a role.”
Other cancers linked to smoking include those of the lung, bladder, cervix, oesophagus and kidney.
© HMG Worldwide 2003
http://www.health-news.co.uk/
Tuesday, July 15, 2003
Smokers face increased risk of prostate cancer
LONDON
By Mark Cowen
Middle-aged men who have smoked regularly for most of their lives are 60 per cent more likely than non-smoking men to develop prostate cancer, according to US researchers.
Previous research results regarding the link between smoking and prostate cancer have been mixed, say the researchers from Fred Hutchinson Cancer Research Centre and the University of Washington.
However, the new study – in conjunction with recent findings from John Hopkins University and Harvard University – point to smoking being an important risk factor for prostate cancer, they say.
The researchers studied more than 1,450 men between the ages of 40 and 64. Half had a history of prostate cancer, while the rest acted as a comparison group. All the participants were interviewed about a variety of factors, including their smoking habits, diet, alcohol consumption and occupational history.
After analysing the results, researchers found significant evidence to suggest a link between smoking and prostate cancer.
They found that men under the age of 65 who had smoked around a packet of cigarettes each day for 40 years, or two packets a day for 20 years, had a 60 per cent increased risk of developing prostate cancer, compared with non-smoking men.
Furthermore, such men were twice as likely as their non-smoking peers to develop more aggressive forms of prostate cancer.
Writing in the July edition of the journal Cancer, Epidemiology, Biomarkers and Prevention, lead author of the study, Dr Janet Stanford, said, “This study provides additional evidence that supports a role for smoking as a risk factor for prostate cancer and confirms recent findings that suggest smoking is an even stronger risk factor for more life-threatening forms of prostate cancer.”
She added, “From a public-health perspective, I think we now have enough evidence to suggest that prostate cancer should be added to the long list of malignancies in which smoking plays a role.”
Other cancers linked to smoking include those of the lung, bladder, cervix, oesophagus and kidney.
© HMG Worldwide 2003
http://www.health-news.co.uk/
Saturday, June 28, 2003
Some Jolly Interesting Questions Answered
This is an example of some of the less orthodox health information you might encounter on the web. This one is not to be taken too seriously - we've place it here for your amusement.
Q: I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart is only good for so many beats, and that's it ... don't waste
them on exercise. Everything wears out eventually. Speeding up your heart
will not make you live longer. That's like saying you can extend the life
of your car by driving it faster. Want to live longer? Take a nap.
Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiencies. What does a cow eat? Hay and
corn. And what are these? Vegetables. So a steak is nothing more than an
efficient mechanism for delivering vegetables to your system. Need grain?
Eat chicken. Beef is also a good source of field grass (green leafy
vegetable). And a pork chop can give you 100% of your recommended daily
allowance of vegetable slop.
Q: Is beer or wine bad for me?
A: Look, it goes to the earlier point about fruits and vegetables. As we all
know, scientists divide everything in the world into three categories:
animal, mineral, and vegetable. We all know that beer and wine are not
animal, and they are not on the periodic table of elements, so that only
leaves one thing, right? My advice: Have a burger and a beer and enjoy your
liquid vegetables.
Q: How can I calculate my body/fat ratio?
A: Well, if you have a body, and you have body fat, your ratio is one to
one. If you have two bodies, your ratio is two to one, etc.
Q: What are some of the advantages of participating in a regular exercise
program?
A: Can't think of a single one, sorry. My philosophy is: No Pain ... Good.
Q: Aren't fried foods bad for you?
A: You're not listening. Foods are fried these days in vegetable oil. In
fact, they're permeated in it. How could getting more vegetables be bad for
you?
Q: What's the secret to healthy eating?
A: Thicker gravy.
Q: Will sit-ups help prevent me from getting a little soft around the
middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should
only be doing sit-ups if you want a bigger stomach.
Q: Is chocolate bad for me?
A: Are you crazy? HELLO ... Cocoa beans .. another vegetable!!! "It's the
best feel good food around!"
Well, I hope this has cleared up any misconceptions you may have had about
food and diets. Have a cookie . flour is a veggie! One more thing....
"When life hands you lemons, ask for a bottle of tequila and some salt."
Q: I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart is only good for so many beats, and that's it ... don't waste
them on exercise. Everything wears out eventually. Speeding up your heart
will not make you live longer. That's like saying you can extend the life
of your car by driving it faster. Want to live longer? Take a nap.
Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiencies. What does a cow eat? Hay and
corn. And what are these? Vegetables. So a steak is nothing more than an
efficient mechanism for delivering vegetables to your system. Need grain?
Eat chicken. Beef is also a good source of field grass (green leafy
vegetable). And a pork chop can give you 100% of your recommended daily
allowance of vegetable slop.
Q: Is beer or wine bad for me?
A: Look, it goes to the earlier point about fruits and vegetables. As we all
know, scientists divide everything in the world into three categories:
animal, mineral, and vegetable. We all know that beer and wine are not
animal, and they are not on the periodic table of elements, so that only
leaves one thing, right? My advice: Have a burger and a beer and enjoy your
liquid vegetables.
Q: How can I calculate my body/fat ratio?
A: Well, if you have a body, and you have body fat, your ratio is one to
one. If you have two bodies, your ratio is two to one, etc.
Q: What are some of the advantages of participating in a regular exercise
program?
A: Can't think of a single one, sorry. My philosophy is: No Pain ... Good.
Q: Aren't fried foods bad for you?
A: You're not listening. Foods are fried these days in vegetable oil. In
fact, they're permeated in it. How could getting more vegetables be bad for
you?
Q: What's the secret to healthy eating?
A: Thicker gravy.
Q: Will sit-ups help prevent me from getting a little soft around the
middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should
only be doing sit-ups if you want a bigger stomach.
Q: Is chocolate bad for me?
A: Are you crazy? HELLO ... Cocoa beans .. another vegetable!!! "It's the
best feel good food around!"
Well, I hope this has cleared up any misconceptions you may have had about
food and diets. Have a cookie . flour is a veggie! One more thing....
"When life hands you lemons, ask for a bottle of tequila and some salt."
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